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Section 1819 of the 1983 Social Security Act (42 U.S.C. 1302 and 1395hh) – Specify a minimum data set of core elements and common definitions for use by nursing facilities in conducting the assessments required under subsection (b)(3), and establish guidelines for utilization of the data set; – The Federal Nursing Home Reform Act from the 1987 Omnibus Budget Reconciliation Act (OBRA) creates a set of national minimum set of standards of care and rights for people living in certified nursing facilities. MDS 4

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The home health Outcome and Assessment Information Set (OASIS) collection regulations (1999 HCFA-3007-F) and (1999 HCFA-3006- IFC) announced the effective date for the mandatory use, collection, encoding, and transmission of OASIS data for all Medicare/Medicaid patients receiving home health skilled services OASIS 5

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Section 4421 of the Balanced Budget Act of 1997 (Public Law 105-33), as amended by section 125 of the Medicare, Medicaid, and SCHIP Balanced Budget Refinement Act of 1999 (Public Law 106-113), and by section 305 of the BIPA: – Authorizes the implementation of a per discharge prospective payment system (PPS), through section 1886(j) of the Social Security Act, for inpatient rehabilitation hospitals and rehabilitation units - referred to as inpatient rehabilitation facilities (IRFs). – The IRF PPS will utilize information from a patient assessment instrument (IRF PAI) to classify patients into distinct groups based on clinical characteristics and expected resource needs. Separate payments are calculated for each group, including the application of case and facility level adjustments. IRF PAI 6

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In accordance with section 1886(m)(5) of the Act, as added by section 3004(a) of the Patient Protection and Affordable Care Act, the Secretary established the Long-Term Care Hospital Quality Reporting (LTCHQR) Program. LTCH CARE Data Set used for electronic submission to CMS standardized assessment data elements Hybrid of Best in Class uniform data elements from the MDS version 3.0 and the Continuity Assessment Record and Evaluation (CARE) Tool Implemented on October 1, 2012 LTCH CARE Data Set 7

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Future State: Data Standardization Facilitates achievement of the National Quality Strategy Six Priorities, and the Three Part Aim – better care, better health, cost savings Facilitates an ability to evaluate the impact/quality related to transitions in care – acute, post acute, LTC, long-term services & community Standardizes communication across providers, service systems Evaluate outcomes across service delivery systems 10

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Assessment Instrument/Data Sets: use of uniform and standardized items Measures harmonized at the Data Element level Providers/vendors have public access to standards Data Elements are easily available with national standards to support PAC health information technology (IT) and care communication Transfer of Care Documents are able to incorporate uniform Data Elements used in PAC settings, if desired Measures can evaluate quality outcomes across multiple settings Measures can follow the person Building the Future State 11

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Facilities are able to transmit electronic and interoperable Documents and Data Elements Provides convergence in language/terminology Data Elements used are clinically relevant Care is coordinated using meaningful information that is spoken and understood by all Measures can evaluate quality across settings and evaluate intermittent and long term outcomes Measures follow the person Incorporates needs beyond healthcare system Keeping in Mind, the Ideal State 12